Overpayments and Recoupment

An overpayment occurs when funds have been paid to a provider in excess of the amount due and payable by Medicare.

Overpayments are either communicated to the provider by Palmetto GBA with the use of a Demand Letter or self-reported by the provider. To be in compliance with Medicare policies for reporting and repaying overpayments, selecting the appropriate repayment method for each situation is critical.

The CMS guidelines governing these processes can be found on the CMS website under:

• Publication 100-05 – Medicare Secondary Payer Manual
• Publication 100-06 – Medicare Financial Management Manual, Chapters 3, 4, 5, and 12

Things to Consider When Determining Payment Method

• Appropriate form to use
• Timeliness of when payment must be made
• Benefits of submitting payment by eCheck using Palmetto GBA’s eServices

Form and Payment Submission
Is the overpayment MSP or Non MSP related? Has a demand letter been issued or is the overpayment being voluntarily sent in to Palmetto GBA? The answer to these will determine which form, if necessary, should be completed and sent.

For provider convenience, payment and contact/address information (where to send form) is included on each applicable form. Palmetto GBA strongly recommends using Palmetto GBA’s eServices portal whenever possible. Providers can electronically submit payments and other requests along with PDF attachments online. For more information, please review the Financial Tools Section in the eServices User Manual (PDF, 7.79 MB)

Palmetto GBA is committed to helping providers understand the options available to them when an overpayment situation occurs. For more information and the options available to you, please select the link below that best fits your situation.

• I received a demand letter for an overpayment
• I have determined I have been overpaid.  What do I do?
• I have a recoupment question
• I would like more information on the quarterly Credit Balance (838) Report